go back

Montana rates for HCPCS 21401

Closed treatment of fracture of orbit, except blowout; with manipulation

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$344.11 / $755.12 / $2,777.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$526.85 / $526.85 / $526.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.52 / $513.32 / $821.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$262.02 / $408.76 / $634.45
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$376.85 / $614.16 / $965.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$672.58 / $812.89 / $936.75